Patients often report that they want their physicians to provide more information about physical activity. Practitioners are likely to counsel patients with known diseases, but generally do not provide regular counseling on physical activity.

Few studies have evaluated the efficacy of primary care counseling for physical activity. The Activity Counseling Trial (ACT), sponsored by the National Heart, Lung, and Blood Institute, was created to examine three different patient education and counseling approaches related to physical activity.

Cardiorespiratory fitness and self-reported physical activity, measured using a 7-day Physical Activity Recall, were evaluated for 874 inactive subjects in the 2-year ACT study. All subjects were given physical activity targets based on national recommendations. The investigators divided subjects into three groups to evaluate the effects of different physical activity counseling interventions. The first group was termed the "advice" care group in which patients received physician advice and written educational materials. Group two, the "assistance" group, received the same as the advice group, plus interactive mail and behavioral counseling at office visits. The third group, the "counseling" group, received all of the above plus regular telephone counseling and behavioral classes.

Cardiorespiratory fitness was significantly higher in women at 24 months in the assistance and counseling groups than in the advice group. Men in all groups demonstrated higher cardiorespiratory fitness, but there were no dramatic differences between the groups at the end of the study; therefore men in all groups improved. Both men and women reported increases in physical activity, but there were no observed differences between groups.

Increased patient interaction may be more effective for increasing physical activity in women. Advice, assistance, and counseling all appear to improve fitness levels in both sexes.

Note: This is the second research paper reviewed in this issue that highlights the importance of a doctor being actively involved in behavior modification of patients for issues pertaining to prevention and wellness.

The Writing Group for the Activity Counseling Trial Research Group. Effects of physical activity counseling in primary care - The Activity Counseling Trial: A randomized controlled trial. Journal of the American Medical Association, August 8, 2001:286(6), pp. 677-687.